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PubMed2003

Evaluation of exercise prescription for hypertensive obese men by ventilatory threshold.

BACKGROUND: Prescription of aerobic exercise for obese subjects with mild hypertension in clinical practice remains to be investigated. METHODS: Forty-one Japanese obese males with hypertension were enrolled and compared with 41 age-and sex-matched obese subjects without hypertension and control subjects. In addition, 25 obese subjects with or without hypertension participated in a one-year follow up study. They were instructed to keep their low exercise intensity and record their daily walking. Before and after exercise prescription, body composition, blood pressure and aerobic exercise level were evaluated. Ventilatory threshold (VT) was determined breath by breath during exercise test using a ramp protocol and rates of oxygen consumption (VO2), work rate (WR), heart rate (HR), deltaHR, %HR max, %HR reserve and rate of perceived exertion (RPE) were measured at VT. RESULTS: At VT, obese subjects with hypertension had significantly lower VO2 (13.5 +/- 2.1 mL/kg/min) and WR (75.1 +/- 16.5W) than control subjects (VO2, 18.1 +/- 5.7; WR, 92.0 +/- 32.4). %HR reserve was also significantly lower compared with control subjects, while %HR max, was not different. RPE was also similar among the 3 groups. By prescribed low-grade exercise during one-year follow-up study, not only body composition but also blood pressure at rest was improved in obese subjects with and without hypertension. CONCLUSIONS: Our results indicated reduced exercise capacity in Japanese obese males. Exercise intensity of 60%HR max, 30%HR reserve and RPE 12 is recommended in obese subjects with hypertension as well as obese subjects without hypertension.

Adult↗
PubMed2006

Muscle dysfunction associated with chronic obstructive pulmonary disease.

Skeletal-muscle (both respiratory and limb) abnormalities are common and can have profound effects in patients with chronic inflammatory states such as chronic obstructive pulmonary disease (COPD). Causes include direct inflammatory-mediator effects on muscle function, malnutrition, blood-gas abnormalities, compromised oxygen delivery from right-heart dysfunction, electrolyte imbalances, drugs, and comorbid states. In COPD patients, respiratory muscles are overloaded, which leads to increased fatigue potential, especially during exercise, when hyperinflation worsens. Interestingly, overloaded respiratory muscles develop structural changes that help them adapt to these conditions. In contrast, limb (especially lower extremity) muscles in COPD patients are underloaded as a consequence of disuse, and this leads to muscle atrophy. Treatment is aimed at optimizing lung function, nutritional repletion, aerobic exercise training, and (in certain patients) oxygen therapy. Resistive breathing training is more controversial. Lung-volume-reduction surgery may help with the hyperinflation effects and improve gas exchange and respiratory-muscle function in selected patients.

Breathing Exercises↗
PubMed1990

The efficacy of incentive spirometers in post-operative protocols for low-risk patients.

Incentive spirometry offered no statistically significant advantages to pulmonary function when compared to unstructured or structured deep breathing and coughing exercise programs, for patients at low risk of developing pulmonary complications. The additional cost of incentive spirometer equipment does not seem warranted in these patients. Furthermore, patients with or without an incentive spirometer were willing to comply with a structured breathing exercise program with the same frequency of practice sessions. Patients in this diagnostic category did not require a technical device to reward and motivate them for performing maximal inspiratory manoeuvres.

Adult↗
PubMed1984

Respiratory mechanics and breathing pattern during and following maximal exercise.

We looked for evidence of changes in lung elastic recoil and of inspiratory muscle fatigue at maximal exercise in seven normal subjects. Esophageal pressure, flow, and volume were measured during spontaneous breathing at increasing levels of cycle exercise to maximum. Total lung capacity (TLC) was determined at rest and immediately before exercise termination using a N2-washout technique. Maximal inspiratory pressure and inspiratory capacity were measured at 1-min intervals. The time course of instantaneous dynamic pressure of respiratory muscles (Pmus) was calculated for the spontaneous breaths immediately preceding exercise termination. TLC volume and lung elastic recoil at TLC were the same at the end of exercise as at rest. Maximum static inspiratory pressures at exercise termination were not reduced. However, mean Pmus of spontaneous breaths at end exercise exceeded 15% of maximum inspiratory pressure in five of the subjects. We conclude that lung elastic recoil is unchanged even at maximal exercise and that, while inspiratory muscles operate within a potentially fatiguing range, the high levels of ventilation observed during maximal exercise are not maintained for a sufficient time to result in mechanical fatigue.

Adult↗
PubMed2000

Effect of skeletal muscle demand on cardiovascular function.

Cardiac output is directed primarily to skeletal muscle during exercise. Recent investigations have examined how different groups of skeletal muscle compete for the cardiac output during exercise. To date, there is a lack of consistent findings on a blood flow steal effect of arm versus leg exercise, although the majority of data suggest that leg blood flow is not compromised when arm exercise is added to leg exercise. A recent set of experiments have demonstrated that respiratory muscles compete favorably for blood flow with the legs during maximal exercise. Decreased work of breathing leads to: 1) a decrease in cardiac output, due primarily to reduced stroke volume; and 2) increased leg blood flow and leg vascular conductance. An increased work of breathing leads to the converse. Exercise performance may also be affected by the work of breathing during heavy exercise due to redistribution of blood flow between the chest wall and the locomotor muscles. It appears that in contrast to arm exercise, respiratory muscles demand a significant portion of the cardiac output during maximal exercise, and the work of breathing normally experienced during heavy exercise compromises leg blood flow.

Arm↗
PubMedDate not supplied

Physiotherapy management of patients with chronic obstructive airways disease.

Various physiotherapy techniques have long been advocated as therapeutic tools for patients with chronic obstructive airways disease (COAD). The purpose of this review is to present an outline of the different techniques, a definition of the present controversies, and an illustration of the possible new directions for physiotherapy in the future. The following aspects of the disease are reviewed: pathophysiology; research; patient education; secretion removal (including techniques of coughing, postural drainage, and percussion); breathing control exercises (including use of the abdominal muscles, nasal inspiration, pursed lip breathing, positioning, alteration of regional ventilation, and the related short and long-term benefits); and thoracic mobility exercises. The authors conclude not only that the physical therapeutic techniques used with COAD patients are extremely diverse in nature, but that the investigations of their validity have been neither comprehensive nor conclusive. Immediate study is needed to define more specific physiological aims for each modality; more selective and effective treatment can then be performed and the true potential of chest physiotherapy realized.

Humans↗
PubMed1988

The peripheral-chemoreceptor threshold to carbon dioxide in man.

1. The threshold of the ventilatory response to carbon dioxide mediated by the peripheral chemoreceptors was determined under mild hypoxic conditions during both rest and exercise in eight volunteers. 2. The method used was an adaptation of the Read rebreathing technique, modified for hypoxia and with prior hyperventilation. The method produced values of ventilation and carbon dioxide which, when plotted against each other, exhibited three straight-line segments of differing slopes. The break-points were interpreted as the resting peripheral- and central-chemoreceptor thresholds. 3. Similar plots of exercise ventilation and carbon dioxide were used to determine the peripheral-chemoreceptor threshold during exercise. However, the points for these plots were obtained from a number of separate rebreathing experiments in such a way as to avoid the divergence between the carbon dioxide levels as measured at the mouth and those at the site of the central chemoreceptors, which would normally occur during rebreathing in exercise. 4. During the course of rebreathing experiments similar to those done at rest, mild treadmill exercise was begun abruptly. The ventilation measured at the third breath of exercise was plotted against the level of carbon dioxide at which the exercise started. In this way, each such rebreathing experiment provided a single point for the plot of ventilation against carbon dioxide in exercise. 5. The results showed that the threshold of the ventilatory response to carbon dioxide mediated by the peripheral chemoreceptors was approximately 39 mmHg (5.2 kPa) while that for the central chemoreceptors was approximately 45 mmHg (6.0 kPa). Neither the peripheral-chemoreceptor threshold, nor the peripheral-chemoreceptor sensitivity to carbon dioxide was changed at the start of exercise.

Adult↗
PubMed1980

Cold air inhalation and esophageal temperature in exercising humans.

This study was performed to examine the dynamics and localization of respiratory heat exchange in exercising humans breathing cold air. Eight normal individuals performed 10 min of exercise at 80% of their predicted Vo2max with inspired air at 22 degrees C, saturated with water vapor; or at -40 degrees C, dry. Rectal temperature (Tre) and temperature at various locations along the length of the esophagus were measured during the exercise period. Temperature in the lower third of the esophagus was in close agreement with Tre and was unaffected by the level of respiratory heat exchange. Upper esophageal temperature decreased substantially during exercise, the magnitude of the decrease being dependent upon proximity to intrathoracic airways and the level of respiratory heat exchange (RHE). We conclude that with high levels of RHE, the capacity of the nasopharynx and upper airways to completely condition inspired air is exceeded. As a consequence, heat and water exchange occur in regions of the respiratory tract not normally involved in this function.

Body Temperature↗
PubMed1993

Chronic obstructive pulmonary disease. Major objectives of management.

The successful management of chronic obstructive pulmonary disease (COPD) depends on achieving three major goals: reduction of airflow obstruction, prevention or management of complications, and improvement in the patient's quality of life. Exercise training is effective in improving the patient's performance; breathing training and education regarding smoking cessation and use of a peak flow meter are also vital to management. Some COPD patients may be suitable candidates for long-term oxygen therapy.

Breathing Exercises↗
PubMed2000

Plasma lactate concentration and muscle blood flow during dynamic exercise with negative-pressure breathing.

This study assessed the hypothesis that increasing cardiac filling pressure (CFP) would enhance contracting muscle blood flow (MBF) by stretching cardiopulmonary baroreceptors and attenuate the increase in plasma lactate concentration ([Lac(-)](p)) during dynamic exercise. Continuous negative-pressure breathing (CNPB) (-15 cmH(2)O) was used to increase the CFP by accelerating the venous return to the heart. In the first series of experiments, 10 men performed a graded exercise seated on a cycle ergometer with (N1) and without CNPB (C1). The increase in [Lac(-)](p) for N1 was attenuated at 60%, 90%, and 100% of maximal exercise intensity compared with that in C1 (P < 0.001). Also, the increases in mean arterial pressure (MAP) and plasma catecholamine concentrations were attenuated in N1 compared with those in C1 throughout the graded exercise (P < 0.05). However, heart rate and pulse pressure were not significantly influenced by CNPB. Second, we studied the impact of CNPB on forearm MBF during a rhythmic handgrip exercise in 5 of the 10 subjects. Forearm MBF was measured immediately after cessation of the exercise by venous occlusion plethysmography at rest, 30%, 50%, and 70% of maximal work load (WL(max)) with (N2) and without CNPB (C2). Forearm MBF and vascular conductance for both trials increased with the increase in intensity, but forearm skin blood flow measured by laser-Doppler flowmetry remained unchanged. MBF and vascular conductance in N2, however, increased more than in C2 at every intensity (P < 0.01) except for MBF at 70% WL(max), whereas the increase in MAP for N2 was attenuated compared with that in C2 (P < 0.05). Thus augmented active muscle vasodilation occurred in N2 with a lower increase in MAP compared with that in C2. These findings suggest that the stretch of intrathoracic baroreceptors, such as cardiopulmonary mechanoreceptors, by CNPB increased MBF by suppressing sympathetic nerve activity. The attenuation of the increase in [Lac(-)](p) might be caused, at least partially, by the increased MBF.

Adult↗
PubMed1992

Effect of oxygen breathing following submaximal and maximal exercise on recovery and performance.

To determine whether supplemental oxygen following exercise hastens recovery or enhances subsequent performance we evaluated its effectiveness in 13 male athletes. The exercise periods consisted of two 5-min submaximal efforts on a treadmill ergometer followed by a single bout to exhaustion. Intervals of exercise were separated by a 4-min recovery period during which the subject breathed either 1) room air, 2) 100% oxygen, or 3) 2 min of 100% oxygen followed by 2 min of room air on three nonconsecutive days. We found that breathing 100% oxygen produced no significant difference on the recovery kinetics of minute ventilation or heart rate, or improvement in subsequent performance as measured by duration of exercise (3.33 +/- 0.04 min, air vs 3.46 +/- 0.03, oxygen) and peak VO2 (59.9 +/- 2.2 ml.kg-1.min-1, air vs 54.5 +/- 2.2, oxygen). In addition, the perceived magnitude of exertion estimated by the Borg scale was no different during oxygen breathing. These findings offer no support for the use of supplemental oxygen in athletic events requiring short intervals of submaximal or maximal exertion.

Adult↗
PubMed1993

Pulmonary gas exchange and breathing pattern during and after exercise in highly trained athletes.

Highly trained athletes (HT) have been found to show arterial hypoxaemia during strenuous exercise. A lack of compensatory hyperpnoea and/or a limitation of pulmonary diffusion by pulmonary interstitial oedema have been suggested as causes, but the exact role of each is not clear. It is known, however, that interstitial pulmonary oedema may result in rapid shallow breathing (RSB). The purpose of this study was therefore twofold: firstly, to determine the exact role of a lack of compensatory hyperpnoea versus a widened in ideal alveolar minus arterial oxygen partial pressure difference [PA(i)-aO2] in the decrease in partial pressure of oxygen in arterial blood (PaO2) and, secondly, to detect RSB during recovery in HT. Untrained subjects (UT) and HT performed exhausting incremental exercise. During rest, exercise testing, and recovery, breathing pattern, respiratory gas exchange, and arterial blood gases were measured. The PA(i)-aO2 and the difference in tidal volume (VT) between exercise and recovery for the same level of ventilation, normalized to vital capacity of the subject [delta VT(%VC)], were then calculated. A large positive delta VT(%VC) was considered to be the sign of RSB. HT showed a marked hypoxaemia (F = 11.6, P < 0.0001), higher partial pressure of carbon dioxide in arterial blood (F = 3.51, P < 0.05), and lower ideal partial pressure of oxygen in alveolar gas (P < 0.001). The relationship between PA(i)-aO2 and oxygen consumption was the same for the two groups. The widening PA(i)-aO2 persisted throughout recovery for both HT and UT. The RSB was observed in HT during recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗